Perineural Fat Grafting in the Treatment of Painful Neuromas

Vaienti, Luca; Gazzola, R.; Villani, Federico; Parodi, Pier Camillo

doi:10.1097/bth.0b013e31823cd218

Cited by 23 publications

(18 citation statements)

References 32 publications

(20 reference statements)

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“…[ 72 , 73 ] Like others we routinely buried the proximal stump in fat. [ 55 , 74 ] Envelopment of the nerve stump in muscle[ 75 ] might give a different effect on pain reduction which will inherently change the predictive value of a block. Given the low values found in our study, it seems unlikely that the effect of envelopment will be of a sufficient magnitude to increase the value of blocking.…”

Section: Discussionmentioning

confidence: 99%

“…Adequate temporary pain relief following the block is considered mandatory before surgery is undertaken. [ 7 – 55 ] [ 56 – 62 ] ( Fig 1 ) There is no objective evidence base for blocking a nerve before nerve surgery is undertaken. Only one study assessed the predictive value of a diagnostic nerve block for the pain relieving effect of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

et al. 2018

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ObjectIn patients with focal nerve injury and neuropathic pain cutting the nerve to obtain permanent pain reduction can be considered. Surgery is indicated only if a diagnostic nerve block provides temporary pain relief. We evaluated the predictive value of a block on the outcome of surgery.MethodsIn total, three blocks were performed at two week intervals. Patients were blinded to injections containing lidocaine 1% and a placebo was included. Surgery was offered regardless of the effect of the blocks. Twenty-four patients received 72 blocks. Sixteen patients opted for surgery, 5 patients refrained from surgery, and in 3 the blocks provided permanent pain relief. The predictive ability of the block on the outcome of surgery was assessed by calculating the area under a Receiver Operating Characteristic curve (AUC).ResultsThe AUC of the first lidocaine block was 0.35 with a 95% confidence interval from 0.077 to 0.62. At 95% confidence (two-sided), the AUC is less than 0.62, and hence the predictive ability of the block was poor. The outcome of the second lidocaine block and saline block did not change the conclusion of the first block.ConclusionsWe conclude that the use of blocks to select patients for surgery should be critically appraised.PerspectiveA pain relieving response to one open block is currently considered mandatory before patients with focal nerve injury and neuropathic pain are offered surgery. Blinded blocks including a placebo show that responses for selection should be carefully interpreted because they may not be as predictive as generally presumed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

et al. 2018

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“…Fat grafting has been shown to improve neuropathic pain from various causes such as postmastectomy pain syndrome, extremity end neuromas, and traumatic and burn scars with sustained responses. 8 – 10 …”

Section: Discussionmentioning

confidence: 99%

“…Several hypotheses have been proposed for the mechanism of pain relief with fat grafting. Vaienti et al 10 proposed that fat grafts act mechanically as cushions around nerve stumps and act biologically by improving local vascularization and reducing inflammation. Sacerdote et al 11 showed in a rodent model that systemic administration of adipose-derived mesenchymal stem cells decreased levels of proinflammatory cytokine interleukin (IL)-1β and increased levels of anti-inflammatory cytokine IL-10.…”

Section: Discussionmentioning

confidence: 99%

A Unique Case of Allogeneic Fat Grafting Between Brothers

Kim

Edelson

Sumpio

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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“…Free fat grafting is one of the new ways to treat neuromas. [43] This technique is minimally invasive and can be repeated. It has been shown to be valuable in treating Dupuytren's contracture and Raynaud's disease.…”

Section: Future Directionsmentioning

confidence: 99%

The management of neuropathic pain from neuromas in the upper limb: surgical techniques and future directions

Laing¹,

Siddiqui²,

Sood³

2015

Plast Aesthet Res

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Neuropathic pain of the upper limb results from damage or disease of the upper limb somatosensory system caused by wide range of pathologies including peripheral neuromas. Treatment strategies depend on making an accurate diagnosis, recognizing co-existing pathologies, and formulating an individualized treatment plan that commonly involves multiple modalities. A long list of nonsurgical and surgical methods acting peripherally (neuromodulation, nerve blocks, surgical manipulation of the nerve) and centrally (medications, spinal cord, and deep brain stimulation) has been described and it is clear that no one treatment is wholly reliable. In this article, we briefly review the pathophysiology of pain caused by neuromas, the current treatment options and the latest research in therapeutic developments.

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Perineural Fat Grafting in the Treatment of Painful Neuromas

Cited by 23 publications

References 32 publications

Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

A Unique Case of Allogeneic Fat Grafting Between Brothers

The management of neuropathic pain from neuromas in the upper limb: surgical techniques and future directions

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